A nurse is caring for a client in a rehabilitation facility.

 

Exhibits

 

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Rationale for Correct Choices:

• Osteoarthritis: Osteoarthritis is the most likely diagnosis given the client’s chronic joint pain and stiffness localized to the knees and hands, as well as objective findings of swelling, reduced range of motion, and obesity. There are no signs of systemic inflammation or autoimmune involvement.

• Administer analgesics: Pain control is a core component in managing osteoarthritis. Acetaminophen is commonly prescribed for mild to moderate joint pain, helping the client to maintain function and engage more effectively in therapy and daily activities.

• Provide dietary counselling: The client has a BMI of 31, indicating obesity, which contributes to worsening joint stress and OA progression. Nutritional counseling helps the client adopt dietary changes that promote weight loss, potentially improving joint function and reducing pain.

• Pain levels: Monitoring pain levels allows the nurse to assess the effectiveness of analgesics and physical interventions over time. It also helps guide necessary adjustments in the care plan to maintain or improve quality of life.

• Joint range of motion: Tracking range of motion provides a measure of disease progression or improvement. It helps determine whether therapy and exercise are effective in preserving or enhancing the client’s joint flexibility and mobility.

Rationale for Incorrect Options:

• Rheumatoid arthritis: RA typically presents with symmetrical joint involvement, systemic signs like fatigue or fever, and is autoimmune in nature. This client has localized symptoms and lacks inflammatory markers.
• Gout: Gout usually causes acute, severe pain in a single joint most often the big toe and is associated with elevated uric acid. The client has chronic joint stiffness and no signs of acute flare.
• Psoriatic arthritis: This condition is associated with psoriasis and may involve dactylitis and skin lesions. There's no mention of skin involvement or other characteristic findings in this client.
• Encourage regular physical activity: While physical activity is beneficial in OA, it should be tailored and introduced after adequate pain control and joint support are established. It is not a priority over analgesia and weight management.
• Educate about joint protection strategies: Education is important for long-term self-management, but initial nursing priorities should focus on symptom relief and addressing modifiable risk factors such as weight.
• Offer relaxation techniques: Relaxation may help with general well-being or coping, but it does not directly address the core impairments caused by OA, such as joint load or pain severity.
• Body temperature: There is no fever or indication of infection or systemic inflammation. Monitoring temperature is not directly relevant in assessing osteoarthritis progression.
• Blood pressure: While important for general health, blood pressure does not provide insight into OA severity or response to treatment.
• Respiratory rate: Respiratory function is not affected by OA and is not relevant to evaluating the outcomes of therapy for joint pain and stiffness.